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The Diagnostic Statistics Assessment (DSA) project is developing a formative, cognitively diagnostic assessment system designed to measure three misconceptions in middle grades statistics. The DSA consists of distracter-driven items, diagnostic score reports, and instructional activities designed to help students reorganize their understandings. The DSA researchers have conducted item development and item revision based on expert review and cognitive labs. Based on these activities, the authors describe the challenges and lessons learned in developing items to target statistical misconceptions at this grade level.